| ObjectiveTaking the patients with cutaneous graft-versus-host-disease after hematopoietic stem cell transplantation as the research object,to understand the current situation and influencing factors of the dermatology life quality in these patients,and under the theoretical guidance of the"health belief model",by using the dermatology life quality index scale,the FACT-BMT scale,the self-made health belief questionnaire and the self-efficacy energy scale as objective evaluation methods to study the clinical effects of health education based on the health belief model.MethodsBefore the experimental intervention,a health belief questionnaire was developed through an expert group meeting.According to the inclusion and exclusion criteria,from2018.1.1-2019.1.1,100 patients in the outpatient and inpatient department of the hematology department of a tertiary hospital in Wuhan was selected to do a cross-sectional survey.To comprehend the status and analysis the influencing factors of the dermatology life quality index of patients with cutaneous graft-versus-host-disease.When conducting experimental interventions,the study is determined to be an experimental study,and the historical control method is adopted.First,through expert group meetings,a health education program based on the health belief model is formulated.Then,a nursing team based on health belief model health education was established.The team members discussed the clinical characteristics,health education,and inclusion and exclusion criteria of cutaneous graft-versus-host-disease,then the team members had to be trained.The training content included methods of health education,principles and standards for the use of scales and questionnaires.Finally,a pre-experiment was conducted to observe a total of 10 cases on the basis of the existing health education program and evaluation indicators of the department,and to study the clinical effect of health education based on the health belief model on cutaneous graft-versus-host-disease under the premise of ensuring medical care.By using a retrospective method,We selected 40 patients with skin graft versus host disease after hematopoietic stem cell transplantation in the Department of Hematology of a tertiary a hospital in Wuhan from 2019.1.1 to 2019.6.30 as the control group according to the inclusion and exclusion criteria;Randomly selected 40patients from 2020.1.1-2020.6.30 in the same department as the experimental group.The control group was given the original routine health education in the department,and the experimental group was given the health education of the health belief model.The nursing team members carried out the health education,by educating and guiding the seven aspects of the follow:susceptibility,severity,patient behavior barriers,self-efficacy,behavior benefits,correction factors,and cues to action.The duration of health education for both groups of patients lasted for 1 month.The collected data was analysed by using SPSS19.0 software.If the data in accordance with normal distribution,counting data were described by frequency and percentage(%)tables,and measurement data were described by means±standard deviation((?)±s).Those did not meet the normal distribution were described by median or quartile interval The analysis of influencing factors adopted one-way analysis of variance and multivariate linear regression.Compared the data of the control group and the experimental group before the intervention,the comparison of general data usedχ~2analysis;the comparison of dermatology life quality index scores,FACT-BMT scores,general self-efficacy scores,and health belief scores between the two groups before and after the intervention use t test.The inspection levelα=0.05.Results1.The average dermatology life quality index score of 91 patients with cutaneous graft versus host disease after hematopoietic stem cell transplantation was 24.57±5.54,of which 28.75%had poor score(1-15),moderate score(16-21)was 52.50%,and good score(22-46)was 18.75%.46.2%of the patients felt a little itching,18.7%felt a lot,6.6%felt a lot,6.6%did not have itching;96.7%of the patients with skin GVHD felt embarrassed or inferiority;in shopping,housework and other aspects,skin GVHD had a great impact on 83.6%of the patients;skin GVHD affected 53.9%of the patients to wear;skin GVHD affected 90.1%of the patients’social impact;Skin GVHD hindered the movement of 54.9%of the patients;skin GVHD hindered the communication of 90.2%of the patients between their family,friends and relatives;skin GVHD affected the sexual life of 86.9%of the patients;81.3%of the patients made a mess or occupied a lot of time because of the treatment of skin GVHD.2.One-way analysis of variance showed that age,education level,source of medical expenses,health beliefs,primary disease,self-efficacy,and ECOG rate had an impact on the dermatology life quality index score in patients with cutaneous graft versus host disease after hematopoietic stem cell transplantation;multivariate linear regression analysis showed:The factors affecting the dermatology life quality index score in patients with cutaneous graft versus host disease after hematopoietic stem cell transplantation are:age,education level,health belief,self-efficacy,and source of medical expenses.5 factors can explain 52.5%of the total variation,of which the the most influential factor of the dermatology life quality index score was health beliefs.3.The comparison of baseline data between control group and intervention group before intervention.(1)Before the intervention,there was no significant difference in the general information between the control group and the intervention group(P>0.05).(2)Before the intervention,the dermatology life quality index scores of the control group and the intervention group were(25.25±5.99)and(23.90±4.84)respectively,and the difference was not statistically significant(P>0.05).(3)Before the intervention,the scores of physical status,social status,emotional status,functional status and stem cell transplantation of the control group were(23.00±6.66),(16.45±3.98),(12.82±5.92),(10.45±5.72)and(18.50±8.90),respectively;the scores of physical status and social status of the intervention group were(22.83±6.67)and(16.50±8.90),respectively(16.95±3.84),emotional status score was(12.45±6.30),functional status score was(10.32±5.78),stem cell transplantation score was(18.85±8.32).There was no significant difference in FACT-BMT score between the control group and the intervention group(P>0.05).(4)Before the intervention,the health belief scores of the control group and the intervention group were(55.52±3.62)and(56.25±6.42)respectively.There was no significant difference in health belief score between the control group and the intervention group(P>0.05).(5)Before the intervention,the self-efficacy scores of the control group and the intervention group were(24.35±1.47)and(24.77±1.71),respectively.There was no significant difference in the self-efficacy scores between the control group and the intervention group(P>0.05).4.Results of skin GVHD health education based on health belief model.(1)After the intervention,the skin quality of life index scores of the control group and the intervention group were(27.47±4.57)and(30.43±4.05)respectively,and the difference was statistically significant(t=-3.05,P=0.003).The skin related quality of life score of the intervention group was better than that of the control group.(2)After the intervention,the health belief scores of the control group and the intervention group were(55.64±3.59)and(58.55±4.94)respectively,and the difference was statistically significant(t=-2.984,P=0.004).(3)After the intervention,the self-efficacy scores of the control group and the intervention group were(25.02±1.12)and(25.77±1.51)respectively,and the difference was statistically significant(t=-2.522,P=0.014).(4)After the intervention,the scores of physical condition in the control group and the intervention group were(18.27±4.83)and(14.90±3.31)respectively,the difference was statistically significant(t=3.642,P=0.000),and the scores of social condition were(16.42±3.99)and(18.15±3.25),the difference was statistically significant(t=-2.118,P=0.000),The scores of stem cell transplantation were(18.47±8.17)and(12.82±5.11)respectively,the difference was statistically significant(t=3.705,P=0.000);the scores of emotional status were(11.82±4.80)and(11.12±4.62),the scores of functional status were(11.17±5.22)and(12.90±4.40),the difference was not statistically significant(P>0.05).Conclusion1.The score of dermatology life quality index in patients with cutaneous graft versus host disease was general.The influencing factors of dermatology life quality index included age,education level,health beliefs,self-efficacy,and the source of medical expenses.Five factors could explain the 52.5%of the total variance.2.Health education based on the health belief model could improve patients’self-efficacy.3.Health education based on the health belief model could improve patients’health beliefs.4.Health education based on the health belief model,by enhancing the self-confidence of patients and strengthening the patients’cognition of cutaneous graft versus host disease,resulting in changes in behavior and habits,thereby improving the quality of life of patients. |
